Renal/urologic Headache is common in patients with chronic kidney disease (Weng et al., 2017). According to Weng et al. (2017), the brain and kidneys show similar anatomical and functional microvascular regulation, which may explain this correlation. Gynecologic Pregnancy Most often headache during pregnancy is a primary disorder, with migraine and tension-type headaches being most frequent (Negro et al., 2017). Many women report that their headaches either go away or greatly improve in the second and third trimesters of pregnancy (Negro et al., 2017). Secondary headaches during pregnancy can be a symptom of several conditions. Negro et al. (2017) identified the following red flags for headache in pregnancy: ● Headache that peaks in severity in less than five minutes. ● New headache versus worsening of a previous headache. ● Change in previously stable headache pattern. ● Headache that changes with posture (standing up). ● Headache that awakens the pregnant woman. ● Headache precipitated by physical activity or Valsalva maneuver (e.g., coughing, laughing, straining). ● Thrombophilia. ● Neurological symptoms or signs. ● Trauma. ● Fever. ● Seizures. ● History of malignancy. ● History of HIV or other active infections. ● History of pituitary disorders. ● Elevated blood pressure. ● Recent travel to locations with higher risk of infective disease. Cerebral venous thrombosis, preeclampsia, hemorrhagic or ischemic stroke, subarachnoid hemorrhage, arterial dissection, reversible cerebral vasoconstriction syndrome, posterior reversible encephalopathy syndrome, idiopathic Neurologic Possible sources of neurologically based headaches are disorders of the cranium or cranial structures (nose, eyes, Neurological symptoms are fairly common with onset of COVID-19, and headache is the most common neurological finding (Bolay et al., 2020). These headaches are often moderate to severe and bilateral with a pressing or pulsating quality. They are exacerbated by bending over. They are located in the temporoparietal area or sometimes more anteriorly to the forehead, periorbital area, and sinuses (Bolay et al., 2020). They are often resistant to analgesics. It is possible that COVID-19 headaches can become chronic as new daily persistent headaches (Bolay et al., 2020). Overlapping with depression and anxiety A strong interaction between headache and depression and anxiety has been established (Wei et al., 2016). Comorbidity of depression or anxiety may cause risk for stronger intensity, longer duration, and more recurrent frequently occurring headaches. Shared biological pathways and norepinephrine and serotonin neurotransmitters are one possible explanation for the cooccurrence of headaches, depression, and anxiety (Wie et al., 2016). Other headache sources COVID-19
Dialysis (first-use syndrome) Headaches are very common in patients who are on dialysis (Sav et al., 2014). According to the International Classification of Headache Disorders criteria, dialysis-related headache is defined as a headache that occurs during dialysis and resolves spontaneously within 72 hours after the dialysis session ends (Sav et al., 2014). intracranial hypertension, and pituitary apoplexy must be ruled out as possible causes of secondary headache. Preeclampsia and eclampsia occur in 5% of pregnancies (Negro et al., 2017). The headache associated with this condition is progressive bilateral (temporal, frontal, occipital, or diffuse), pulsating, and aggravated by physical activity; it also fails to respond to over-the-counter remedies (Negro et al., 2017). Other symptoms associated with preeclampsia and eclampsia are high blood pressure, changes in vision, shortness of breath, increased edema, and nausea and vomiting (Preeclampsia, n.d.). Headache related to reversible cerebral vasoconstriction syndrome is severe and diffuse—typically thunderclap; recurring over one to two weeks; and often triggered by sexual activity, exertion, Valsalva maneuver, and/or emotions. This condition usually occurs within one week following delivery (Negro et al., 2017). During the first trimester, women who are obese can suffer from a progressive, daily headache that is aggravated by the Valsalva maneuver and position change, associated with papilledema and severe visual deficits, and accompanied by tinnitus. This is the clinical pattern for idiopathic intracranial hypertension (Negro et al., 2017). Pituitary apoplexy is a rare cause of sudden and severe headache during pregnancy. This severe headache is accompanied by nausea, vomiting, ophtalmoplegia, and altered consciousness. Most cases occur as the first presentation of rapid enlargement of nonfunctioning pituitary macroadenomas as a result of hemorrhage and/or infarction (Negro et al., 2017).
ears, teeth, neck), headaches that occur post seizure, brain abscess, and hydrocephalus.
Evidence-based practice: Since headache is the most common neurological symptom COVID- related, COVID infection should always be considered as a possibility reason for new-onset headache. In addition, long COVID headache can present in the form of a preexisting primary headache or in the form of a new intermittent or daily headache with migraine or tension- type headache symptoms. It is thought that it is related to persistent activation of the immune and trigeminovascular systems (Bolay et al., 2020). Side effect of medication The introduction of any new drug can be associated with the new onset of headache and can be considered a sign of incompatibility with that drug (Do et al., 2019). When reviewing a client’s medication list, special attention should be paid to the addition of any new medications.
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